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Documents & forms

Paperwork, minus the clipboard

Download what you need before the first visit, fill it in at your own kitchen table, and spend the waiting room time not writing.

New patients

UMBHS Intake Form (New Patients)

The standard intake packet: your history, current medications and consents. Complete it before your first appointment and bring it with you, on paper or on your device.

Download the intake form (PDF)

What to bring to a first appointment

  • The completed intake form above, or arrive early and complete it with us.
  • Your insurance card, if you are using insurance.
  • A list of current medications and doses, including anything over the counter.
  • Records from previous treatment, if you have them and want them reviewed.
  • Photo identification.

Other documents

Records requests, release-of-information forms and anything else administrative are handled directly by the office: send a secure message(info@uniquembhs.com) or call(443) 538-8400 and we will get you exactly what you need. Our privacy policy and HIPAA notice describe how your information is protected.

Form in hand? Book the appointment.

Request an appointment online at any time, or speak to somebody during office hours.

Book an appointmentCall (443) 538-8400

Prefer to write? Send a secure message

Request a callback

Leave your number and a real person will call you back. No pressure, no obligation.

By requesting a callback, you agree to ourTerms andPrivacy Policy, and consent to us contacting you. See ourNotice of Privacy Practicesfor how we protect your health information. If you're in crisis, call or text988 now.

Check your insurance

Tell us who you're insured by and we'll verify your benefits, then call you back, usually within one business day.

Your plan
Policyholder
Photos of your card (optional)

Fastest way to get an accurate check. Photos are sent encrypted and are never stored on this website.

Submitting sends your details to our team over an encrypted, HIPAA-compliant connection. See our Notice of Privacy Practicesand Privacy Policy. If you're in crisis, call or text988 now.

Request an appointment

Tell us when suits you and we'll confirm by phone, usually within one business day.

When would suit you?

These are typical openings in our published hours. We'll confirm the exact time with you.

Submitting sends your request to our team over an encrypted, HIPAA-compliant connection.This is a request, not a confirmed appointment. We'll call to confirm. See ourNotice of Privacy Practices. If you're in crisis, call or text988 now.